24 hours can be a lifetime

5:30am Wednesday 30th July 2014 in

Allison Salmon goes about her busy, life-changing day

Around 7,300 people in the UK currently need a transplant. Of these, 1,000 – three a day – will die waiting as there are not enough organs available. The Organ Donation Service at the Great Western Hospital offers support to bereaved families to help them make informed choices. Specialist Nurse for Organ Donation, Allison Salmon, takes us through her day

8am: I leave home for the hospital where I am based. A day on call to look forward to.

8.30am: I join the ward round on the Intensive Care Unit (ICU). This is often where patients are referred to me or where discussions around end-of-life care happen.

9am: I receive a handover email from Nadine, the SNOD (Specialist Nurse Organ Donation) that has been on call overnight.

9.30am: I make the daily calls to hospitals within our region. This is to find out if there are any patients they are planning to test for a brain stem death (when a person no longer has any activity in their brain) or withdraw treatment on – there is nothing at present.

10am: Today I have a teaching session with some Junior Doctors. The aim is to raise their understanding of organ donation. The Junior Doctors receive the training very well, with lots of interesting questions and debate around the religious and ethical issues involved in donation.

12.30pm – Lunchtime!

1pm: My pager goes off. It’s one of the hospitals in the south of our region. I speak to a registrar on the neurosurgical intensive care unit. He tells me about a young man in his 20s who was admitted 48 hours earlier following a road traffic collision. We discuss his past medical history and family details. I take the patient’s details in order to check the Organ Donation Register (ODR).

I inform the doctor that the young man would be an eligible donor and I will come to the hospital to talk to the family.

1.20pm: I check the ODR – he is registered. I book a taxi to take me to the hospital.

2.30pm: I arrive at the hospital, talk to the doctor who referred the patient and review the medical notes.

3.30pm: I speak to the family and ask them about organ donation. They knew he was on the ODR and are fully supportive as they knew it was their son’s wish to help others after his death. Speaking to parents who have just lost their child can be difficult and sad. Every family is different and have different strategies for coping with their loss. I have the time to sit with them and give them the information at a pace that is right for them. We give them information in order for them to make an informed decision.

My job is to support them throughout the process and that can be anything from just listening to them vent their anger to providing practical help with phone calls or refreshments. I try to focus on the fact that something positive can come out of such a sudden and tragic loss.

4pm: I get formal consent from the family and complete a patient medical assessment form. I then talk to them about the donation process and about their wishes for care after death.

5pm: As the man’s death was sudden, I get permission from the coroner so that we can go ahead with donation. He gives full permission with no restrictions.

6.30pm-9.30pm: I ring recipient centres throughout the country in order to find suitable recipients for the organs that can be donated.

10pm: Recipients have been found for heart, lungs, liver, kidneys and pancreas. I mobilise the abdominal retrieval team.

10.30pm-1am: I complete my paperwork and the patient is cared for in ICU.

1am: The transplant teams arrive in theatre. I hand over to them and assist in transferring the patient to theatre.

1.30am: The operation begins. Once we are sure all the organs are healthy, I relay this to the recipient centres so they can start to prepare the recipients for their transplants.

6am: The operation is over. I have to ensure the organs are safely dispatched to the recipient centres. The heart and lungs are going to a centre at the other end of the country so I have to ensure a plane is on standby to get them in the air ASAP.

7am: Once all the organs have left the operating theatre, I am left alone to carry out last offices for the donor. It is the final thing I can do for him so I wash him, wash his hair, clean his teeth, dress his operation site and put him in a gown. He is then transferred to the mortuary. To carry out the last offices for someone who has given the ultimate gift is a humbling but proud task.

I always promise the family I will look after their loved one and that they are treated with the dignity and respect that they deserve.

7.30am: I finish my paperwork and prepare handover to the oncoming on call person.

8am: I arrive home. I ring the patient’s parents as promised to let them know what organs their son has generously donated. They are extremely grateful that I stayed with him throughout.